She rushed to Skyline Medical Center, and the moment she stepped off the elevator a “Code Blue” was called.

Mary Neal Martin, 89, had just suffered a stroke in what would become the final blow in a desperate but hopeless battle against fungal meningitis brought on by a tainted steroid injected in her spine.

She died on Oct. 25 after her transfer to Alive Hospice in Madison, just a little more than seven weeks after receiving the back pain treatment.

At her death, the lifelong Nashville-area resident became the 10th of what is now 14 people who have died from tainted steroid shots in Tennessee. Many more remain sick, and 78 of 145 sickened by shots in Tennessee have developed meningitis.

Tennessean interviews with those struggling to recover and families of those who died show that the pain and suffering wrought by the outbreak could continue indefinitely.

“I think most people have forgotten,” said Reba Skelton, 66, of Waynesboro, Tenn., who like many recovering victims struggles daily with unending fatigue and weakness.

“I’m exhausted,” she said. “I’m having a lot of trouble. I have trouble sleeping. It’s been very difficult both financially and mentally.”

Skelton, who got her steroid shot on Aug. 17, said her condition was not diagnosed immediately and she was never actually notified about the outbreak.

“I heard it on television,” she said.

For Skelton, like many other victims, the shots administered at St. Thomas Outpatient Neurosurgery Center were a last-ditch effort to end severe pain without risky surgery.

She said the only call she got was from her doctor’s office asking her how her shot was doing. “No one told me anything was wrong,” she said.

But when she called to schedule another injection, Skelton said, she was told there was “an equipment problem.”

“When I called and asked them what was going on, at one point they told me there was nothing they could tell me,” she said.

She said she already was experiencing a severe headache, one of the meningitis symptoms, but mistakenly assumed it was a sinus problem.

Skelton was hospitalized for 17 days and still has to commute back and forth, 100 miles each way, to Nashville for tests, including spinal taps, and treatment.

She said the anti-fungal medication has interfered with her regular blood pressure medication. But when she switched to another blood pressure medication, she said, her pressure went out of control.

Fighting off meningitis

Shirley Higdon, 74, of Decatur County, Tenn., traveled 90 miles to Nashville for a steroid shot on Sept. 10 and, like Skelton, became sick soon afterward.

Reached at her Parsons home, she said she was too weak and tired to talk. “I really don’t feel good,” she said.

Higdon’s continued pain is due to the potent anti-fungal treatments, which come with severe side effects that have reshaped the lives of the victims of the meningitis outbreak, court records show.

Nashville resident Joan Peay, 72, had to be hospitalized in November because severe nausea made eating impossible.

“I couldn’t keep anything down,” Peay said. “They invited a special doctor, and she found something for the nausea. That’s been the greatest blessing.”

The victims have been told the anti-fungal medication carries even more severe side effects, such as kidney and liver damage.

Before they worry about long-term complications from their new medicine, Peay and others mark the time by pursuing minor victories.

Peay said she will have a procedure later this month to find out the severity of the remaining fungal infection in her spinal fluid. Though her stomach pain has eased, Peay said she still has trouble eating.

“I just want to get rid of this nausea and this taste in my mouth,” she said.

Dennis O’Brien, of Jamestown, Tenn., said he has his sights set on the spring, when he hopes his strength will have returned so he can walk around his yard, enjoy the flowers blooming and the birds singing, and, with any luck, the sounds of someone else mowing his yard.

O’Brien, 59, especially longs for the day when he can reach out and pick up his 3-year-old granddaughter.

He pointed out the recovery process is as burdensome on family members as it is on the victims. He said his wife, Kaye O’Brien, who works as a teacher, has had to miss work while she helped care for him, in addition to the difficult experience of watching her husband be stricken with such a severe and unprecedented infection.

“It’s probably been tougher on my wife,” he said. “I’m not myself, I’m not me. Do I eat? Do I not eat? It’s been stressful for her.

“It’s not easy being the nurse instead of the patient, but life has to go on all around us. I have an excuse to sit around and not do much. But we used to be two partners; now we’re one and a third. I’m a third of my former self.”

O’Brien is hopeful that his doctors will prescribe a less powerful anti-fungal medication in the coming months.

“We’re three months in, and I want it to be over, and it’s not over,” O’Brien said. “It’s going to be months and months more.”

Medical bills mount

Besides severe physical pain, victims of the outbreak are also dealing with the added stress of navigating the legal fallout. For many victims, this is their first foray into a legal tussle, as they’ve filed lawsuits against New England Compounding Center, which produced the tainted steroids.

“There’s not going to be enough water left in that well for me to get anything,” O’Brien said.

But while the legal proceedings remain in limbo because of New England Compounding Center’s bankruptcy, medical bills continue to pile up for victims of the outbreak.

Nashville attorney Rob Briley said the cost of treatment since his client Barbara Taylor of Lexington, Tenn., was diagnosed with meningitis has reached $700,000.

“She is one of many people who have run up enormous hospital bills,” Briley said, adding that it would be a burdensome cost even for those with health insurance.

Families of victims

Nationwide, the outbreak has sickened 678 and killed 44. State and federal regulators say it was caused by impure fungus-ridden methylprednisolone acetate, the medication administered to relieve severe back and joint pain.

Public health officials have not released the names or exact dates of those who have died from the shots. But The Tennessean, through interviews with family members, and examination of lawsuits and certain death records, has been able to determine 10 of the 14 victims. Those 10 received shots at the Saint Thomas Outpatient Neurosurgery Center in Tennessee.

They span two states — Kentucky and Tennessee — and range in age from 55 to 89.

Most were in their 70s. like J.W. Ragland, 72, who made the 55-mile trek to Nashville from his home in Adolphus, Ky., in search of relief from the pain of chronic back problems.

Retired from his job as a foreman at a TVA heavy machine shop in Clarksville, Tenn., Ragland was active in the Masons and in 2009 served as master of Graham Lodge #208 in Scottsville, Ky. His welcome message is still posted on the lodge website. His hobbies included gardening.

Becky, his wife of 38 years, said that the shots he received at Saint Thomas on July 30, Aug. 13 and Aug. 27 did no good.

“It didn’t help his back pain at all. It got worse,” she said. He died Oct. 16.

She said they found out about the tainted steroids not from his doctors but from news reports. Even after they went to Saint Thomas, his testing had to be delayed for three days because he was taking a blood thinner.

This was not the first tragedy to hit the Ragland family. Their daughter, then 17, died in a 1983 car accident.

Death comes too soon

Mary Neal Martin, Mama Neal to her great-grandchildren, was not a big woman, “barely over 5 feet and a hundred pounds on a good day” according to daughter Patricia.

A stay-at-home mom until Patricia and Larry graduated from high school, she worked for some 25 years at the Three Sisters, a Madison Square dress shop and later a nearby shoe store. Before the children were born, she had worked in an aircraft factory.

She loved to cook and could make a “marvelous meatloaf” in a skillet, not the oven.

“She would never go on a visit without bringing some food along,” her daughter recalled.

Though she was generally in good health, last summer a back problem began to worsen to the point that she had difficulty getting around.

The steroid shots had been suggested before, but Mary Martin had deferred and begun using a three-legged cane.

But the pain intensified beginning about six months to a year ago, Larry Martin recalled.

“We decided it was time,” Patricia Martin said.

Like Skelton, Mary Martin began a series of steroid shot treatments at Saint Thomas Outpatient Neurosurgery Center. She had shots on Aug 7, Aug. 21 and Sept. 3, and she seemed to be getting some relief until a week or so after that last shot.

Then came flu-like symptoms and worsening head and back aches, which continued despite a rescue package of Jell-O, soda and other goodies delivered by her daughter.

After finding that getting a doctor’s appointment would entail a delay of several days, they agreed to bring her to the Skyline emergency room, where she was admitted. At the time health officials had not announced the outbreak.

“They suggested a lumbar puncture. Obviously they had a pretty good idea of what was going on,” Larry Martin said. “She was in a lot of pain. After about two or three weeks she started to lose touch. Then she rebounded, but on Friday, Oct. 19, she suffered a stroke.”

Asked about his feelings nearly three months after his mother’s death, he said, “Just sad and disappointed and beginning to get angry. Mom was 89, and at that age you don’t know how much time you have left, but I know for sure she should not have died on Oct. 25.”